OA Update: Injury Prevention, Athletic Performance and Orthopedic Procedures

OA Joins Specialty Groups to Form Maine’s Largest Independent Practice Association

OA recently joined three of the Portland Maine area’s most prestigious specialty medical groups to form a new Independent Practice Association (IPA). The largest of its kind in Maine, the IPA represents over 250 physicians and other medical providers caring for patients in Southern Maine and across the entire state.

Popular in other parts of the country, an IPA consists of a network of physicians who agree to participate in an association to contract with health insurance companies and other payer organizations. Members of the Maine Specialty IPA will maintain their independent physician ownership structures and will seek to achieve cost efficiencies by sharing administrative services.

“This association will be a source of improved performance for our practices,” said Dr. Thomas Murray, OA surgeon and sports medicine specialist. “Additionally, the IPA becomes a potential vehicle for other independent medical groups wishing to collaborate and gain the benefits associated with further alignment of clinical and business best practices.”

In forming Maine Specialty IPA, the physician association is countering a trend towards hospital-based employment and away from independent practice. Economic pressures in the form of rising costs and lower payments for procedures have forced many private practice medical groups in Maine to give up their independence and to become employed by ever larger regional health organizations.

In the primary care area alone, approximately 2,000 Maine physicians are now employed in practices that are owned by hospitals or federally qualified health centers (FQHC), according to Gordon Smith, Executive Vice President of the Maine Medical Association. This means that approximately 70% of all medical doctors in Maine are in an employment relationship with a hospital, health center or FQHCs, whereas 10 years ago that number was less than 15%. On the specialty side, about half of the specialists now have such an employment arrangement, whereas only a small number of specialty physicians were employed by hospitals ten years ago.

Members of the newly formed IPA believe that by combining their resources, they can be effective in providing physician-led solutions to the challenges facing Maine and the nation as it relates to the delivery and financing of healthcare services.

“This collaboration will enable our physicians to work more closely together to improve the coordination of patient care, address cost issues in healthcare, and promote strong, independent physician practices,” said Dr. Daniel Landry, President of Spectrum Medical Group.

Other medical practices have approached the association, which is limited initially to the founding members, which include Chest Medicine Associates, Portland Gastroenterology Associates, Spectrum Medical Group and OA Centers for Orthopaedics.

UMaine Female Player, Rachel Burns, Fights Through Multiple ACL Injuries

The January 16, 2011 edition of the Maine Sunday Telegram featured an article by staff writer Jenn Menendez about UMaine player, Rachel Burns. After three surgeries to her right ACL, Burns tore her left ACL after only 5 games back into her season. Dr. Thomas Murray, OA orthopedic surgeon and sports medicine specialist, assisted with the story by providing the reporter with information about the nature of the injury and the growing epidemic among female athletes.

Explaining the difference between boys and girls, Murray is quoted as saying, '"What happens for girls in general, it's not how they jump, but how they land," said Murray. "Their knee tends to turn in or buckle. Boys land with a wider base of support."'

"Hurt Girls, Revisited: ACL Injury and Surgery Epidemic" originally published in this blog in 2008 provides much greater detail about the nature and extent of ACL injuries among female athletes.

Proper training, conditioning and learning the proper mechanics of starting, stopping and jumping can help mitigate ACL injuries among female athletes. Referring to the OA Performance Center in Saco, reporter Mendendez notes, '"OA runs a training center in Saco designed to strengthen the joint for athletes looking to return from surgery or prevent the injury."'

The article goes on to say, "Athletes can focus on preseason conditioning for muscles, endurance and agility drills… but returning to the court or field comes with risk."

'"There is always concern for repeat injury. I'm sure her doctors will talk to her about the risks associated, should you keep going back," said Murray. "That conversation will happen. But every patient has their own set of values."'

OA wishes Rachel Burns a speedy recovery and healthy return to the court.

 

Medical Advances Provide Options for Hip Pain - Explaining Hip Arthroscopy

By Benjamin H. Huffard, M.D.

Each year more than 7 million people visit their doctor with concerns related to hip pain. For many, the pain is so severe that simple things like climbing stairs or bending to tie their shoes are difficult. Some may even have back or groin pain and not realize this pain is actually the result of a hip condition.

Many patients find pain relief through anti-inflammatory medications, physical therapy or the right kind of exercise. But for others, only surgical intervention will help.

Thanks to recent medical advances, patients with ongoing hip pain who don’t require a hip replacement may now be treated with minimally invasive surgery. The procedure, called hip arthroscopy, allows surgeons to diagnose and repair most injuries through tiny incisions in the hip instead of larger incisions like those needed for replacements. This less invasive approach usually means less pain and a quicker recovery for the patient.

While hip replacement surgery may be needed if there is severe hip trauma or damage from arthritis in the joint, hip arthroscopy is most often used to treat a specific and less severe condition that may be causing pain. This makes it beneficial for younger, more active people.

Historically, active individuals in the 30–50 age range with chronic hip pain were more or less told to live through their pain until they reached an age when a hip replacement was feasible. Physicians used this approach because practical treatment option simply wasn’t available. In some cases, doctors couldn’t even determine the cause of a patient’s pain because the injury wasn’t detectable on an x-ray.

As diagnostic techniques and instruments for the hip have improved, more and more doctors are now using hip arthroscopy to diagnose and treat injuries such as labral tears, the most common problem in the hip joint. The labrum is the ring of cartilage that surrounds the rim of the hip socket, also known as the acetabulum, and acts as a cushion. Labral tears can occur as the result of an accident, through overuse or sometimes through basic wear and tear.

In addition to labral tears, two other injuries commonly treated with arthroscopic procedures are hip impingement, a condition in which a lack of room between the head of the femur, or the ball, and the acetabulum, or socket, causes painful friction when the hip is flexed and the removal of loose bodies in the joint—small pieces of soft tissue or bone that are usually the result of trauma such as a fall, accident or sports injury.

Similar to knee and shoulder arthroscopy, which have been performed for many years, hip arthroscopy includes the use of a narrow scope and specialized instruments. The scope is attached to a camera and is inserted into the joint through a small incision, allowing the surgeon to see the injury and the area surrounding it. The hand instruments are inserted through another incision and are used to remove or repair the damaged tissue. Because the whole procedure is performed through keyhole-size incisions, the patient can usually return home that same day. In many cases, hip arthroscopy allows for a quick return to activity, with the least amount of pain possible, while also diminishing the risk of arthritis and possibly even delaying the need for a hip replacement.

Dr. Huffard spent a year as a sports medicine fellow at the Steadman Hawkins Clinic in Vail, Colo., training with Dr. Marc Philippon on minimally invasive and arthroscopic treatment of soft tissue injuries around the hip. Dr. Huffard specializes in arthroscopic surgery of the shoulder, knee and hip.

Sports-Related Concussion

By Lucien R. Ouellette, MD

No athlete should return to sport or other at-risk participation when symptoms of a concussion are present and recovery is ongoing. The best way to prevent difficulties with a concussion is to manage the injury properly when it does occur. Here are some commonly asked questions and answers regarding concussion injuries:

What is a concussion?

A concussion is any temporary change in how the brain works caused by injury to the head that may or may not involve a loss of consciousness. This can be a direct blow to the head or a hit to the body causing shaking of the head. Another term for concussion is mild traumatic brain injury (MTBI). A sports-related concussion is specific to an injury while playing sports and will temporarily limit involvement with sports.

Is sports-related concussion common?

Yes, sports-related concussion is common especially in collision sports like ice hockey, boxing and football, but a sports-related concussion can occur in any sport. Estimates are that 5 percent of injuries in high school sports are concussions, with a higher rate in certain sports (60 percent in football).

Unfortunately, many more concussions go unrecognized and untreated.

How do I know if I have a concussion?

Symptoms of a concussion can be very subtle (irritability, ringing in the ears, nausea, difficulty concentrating, difficulty sleeping, personality changes, sensitivity to lights or sounds or just not feeling right). Symptoms can also be more obvious (headache, confusion, loss of memory, clumsiness, change in vision, appearing dazed). ANY change to normal brain function is a concussion no matter how minor the symptom may be or how long the symptoms last. Even a “ding” or getting your “bell rung” is a concussion.

What do I do if I have a concussion?

Tell your athletic trainer, team physician or sports medicine specialist. The only treatment for sports-related concussion is rest. This will involve stopping all sport participation until all symptoms have resolved and to return with a slow increase in activity without symptoms recurring. Sometimes rest needs to include limiting school or work activity. If the symptoms are prolonged (more than seven days), your doctor may be able to help the symptoms with some medications; typically, no medications are needed.

Will my brain return to normal?

With a single concussion and appropriate rest, typically you will regain all your normal brain function within 7–10 days. Sometimes a neuropsychological test (ImPACT) will be used to help determine when normal brain function has returned. We cannot determine how severe a concussion is until all the symptoms have gone away, and we have no way to predict when they will resolve. We do not know how many concussions one person can have in a lifetime before permanent brain injury occurs. This number is different for each person. We only know if the damage is permanent when the symptoms don’t go away.

Can I prevent a concussion?

The only way to prevent a concussion is to avoid injury to your head. No equipment (helmet, mouth guard) has been proven to decrease the rate or severity of concussion, but they do prevent other injuries (cuts, tooth damage, eye injury, etc) and should be worn.

Dr. Ouellette is a sports medicine physician who serves as team physician for Bowdoin College and Old Orchard Beach High School. He assists with coverage for the Portland Pirates (AHL) and the U.S. National Soccer Teams. He utilizes the ImPact test on his athletes to ensure a safe return to sports.